January 12, 2018

Chatbot: The Therapist in Your Pocket

Artificial intelligence (AI)-powered chatbots provide a new form of mental health support for a tech-savvy generation already comfortable using texting as its dominant form of communication.

As the demand for mental health services grows nationwide, there’s a shortage of available psychiatric professionals, according to the National Institute of Mental Health. And college campuses are seeing unprecedented rates of anxiety and depression.

Chatbots designed to spot indicators of mental health distress may provide emotional support when traditional therapy is out of reach.

While these chatbot counselors don’t replace the critical human touch essential during a personal crisis, AI and machine learning can enable the mental health community to reach more people and ensure consistent follow up, according to Michiel Rauws, co-founder and CEO of the mental health tech startup X2AI.

“There are millions of people globally who struggle with anxiety and depression, and simply not enough psychologists to take care of everyone,” Rauws said.

Based on his own experience with depression and work with immigrants affected by the war in Syria, he realized that much of cognitive behavioral therapy (CBT) is about coaching people to reframe how they think of themselves and their lives. He developed Tess, an AI chatbot that helps psychologists monitor patients, and remotely deliver personalized psychotherapy and mental health coaching.

“I had learned the psychological techniques and innovations, and realized that I might help others,” he said.

Now 27, Rauws says his generation often feels more comfortable chatting about sensitive issues via text rather than in person at a therapist’s office.

Available through text, web browsers and Facebook Messenger, Tess is offered through healthcare organizations to provide care whenever and wherever a patient needs it.

In addition to helping patients work through their issues, the AI chatbot also recognizes signals that indicate an acute crisis, such as suicidal thoughts. It alerts a human therapist when emergency intervention is essential.

The Digital Doctor is In

Several companies are developing mental health-related chatbots for direct consumer use, including the Woebot, a digital mental health coach that uses CBT to help users deal with anxiety or depression.

“Woebot is a robot you can tell anything to,” Woebot CEO Alison Darcy told Wired. “It’s not an AI that’s going to tell you stuff you don’t know about yourself by detecting some magic you’re not even aware of.”

Using Facebook Messenger, Woebot uses talk therapy prompts such as “What’s going on in your world right now?” This helps people talk about their emotional responses to life events, and identify the traps that cause stress and depression.

There’s no Freudian psychoanalysis of childhood wounds, just solutions for changing behavior. Woebot notes CBT is based on the idea that it’s not events themselves that affect people, it’s how they think about those events. What people think is often revealed in what they say.

This is just the beginning of a new era of tech-enabled mental health care. Machine learning has become so sophisticated that it can read between the lines of conversations and look for warning signs, according to researchers at IBM.

IBM used cognitive systems and machine learning to analyze written transcripts and audio recordings from psychiatric interviews to identify patterns that can indicate, and maybe even predict, mental illness.

It takes only 300 words to help clinicians predict the probability of psychosis, according to Guillermo Cecchi, a neuroscientist and researcher at IBM Research.

AI technology can help in identifying patterns of thinking.

In five years, the IBM team predicts that advanced analytics, machine learning and computational biology will provide a real-time overview of a patient’s mental health.

Bringing Care to Rural Areas

These CBT technologies could meet a growing need for mental health care among the younger generation. Rates of depression and anxiety among young people are rising, according to the American College Health Association (ACHA).

Within the past year, 50 percent of college students reported feeling that things were hopeless, 58 percent felt overwhelming anxiety and 37 percent felt so depressed it was difficult to function. While universities encourage students to seek help, the social stigma still associated with mental illness can keep them from looking for a traditional therapist, according to ACHA research.

Chatbots may also help address the shortage of mental health services in rural areas where patients drive long distances to see a therapist face-to-face, said Gloria Zaionz, tech guru at the Innovation Learning Network, a think tank in Silicon Valley that studies how technology can improve healthcare.

More than 106 million people live in areas that are federally designated as having a shortage of mental health care professionals, according to the Kaiser Family Foundation.

“Mental health professionals are often limited in their capacity to provide treatment, and there are other barriers like wait times, cost and social stigma that can prevent people from getting the support they need,” Rauws said.

Companies are careful to note that AI chatbots are not intended to replace in-person treatment, but rather to expand limited access to mental health services. The tech provides more ways for patients to check in between visits and receive consistent follow-up care.

Data on the effectiveness of AI therapy is limited, but early results look encouraging, according to Rauws at X2AI. He said a trial of Tess across several U.S. universities showed a decrease in the standard depression scale and anxiety scale scores. A pilot study of Woebot also reported reduced levels of depression and anxiety.

Through a simple text conversation, AI may help in overcoming the stigma of seeking mental health care, ultimately expanding the reach of services. And a seemingly nonjudgmental chatbot may encourage people to honestly answer the question, “Are you OK?”

“There’s something about the screen that makes people feel a little bit more anonymous,” said Zaionz, “so they open up more.”